AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2693-2156/009
1 Associate Professor, Department of Radiology, Rajaie Cardiovascular and Medical Research Center, Iran University of Medical Sciences, Tehran ,Iran
2 Department of radiology, John’s Hopkins hospital, Baltimore, Maryland, USA
3 Department of Radiology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran – GI/Liver, Department of Medicine, University of Southern California, LA, CA, USA.
4 Bachelor of Radiology, Rajaei Cardiovascular Medical and Research center, Iran university of medical sciences, Tehran, Iran.
5 Assistant Professor, Department of Radiology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran.
*Corresponding Author: Maryam Mohammadzadeh, Assistant Professor, Department of Radiology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Citation: Ali mohammadzadeh, Sadaf sahraian, Layla shojaie, kianosh kasani, Maryam mohammadzadeh, (2020) Assessing the Diagnostic Value of Dual-source CT angiography for Congenital Thoracic Vascular Anomalies. J Thoracic Disease and Cardiothoracic Surgery, 1(2); DOI:10.31579/2693-2156/009
Copyright: © 2020 Maryam Mohammadzadeh, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 18 June 2020 | Accepted: 03 July 2020 | Published: 08 July 2020
Keywords: computed tomography angiography; congenital abnormalities; sensitivity and specificity
Background and objectives: Congenital thoracic vascular anomalies are associated with great risk of mortality and morbidity. Their growing incidence is assumed to originate mainly from the increased accuracy of the diagnostic methods used. Although classic angiography is considered the gold standard diagnostic method, various diagnostic methods have been proposed. Dual-source computed tomography (DSCT) angiography is the most recently introduced CT technology with confirmed diagnostic accuracy in adult population. The present study is aimed to determine the diagnostic value of DSCT in children with congenital thoracic vascular anomalies compared with the gold standard CTA.
Materials and methods: The present cross-sectional study investigated the diagnostic accuracy of DSCT in 100 pediatric patients who referred to Shahid Rajaie Heart Center with congenital anomaly of major thoracic vessels and underwent DSCT and angiography from March 2011 to September 2014. DSCT images were reviewed by one radiologist to confirm the accuracy of reports. Next, parameters of diagnostic value of these methods were compared using IBM SPSS version 22.
Results: A total of 142 cardiovascular anomalies were diagnosed by angiography. The diagnostic accuracy of DSCT was 97.1%, considering 2 cases of left superior vena cava and 2 patent ductus arteriosus missed by DSCT among the 142 anomalies diagnosed by angiography. DSCT also provided important additional findings (n = 26) which were not reported by angiography.
Conclusion: DSCT is a highly accurate diagnostic method for detecting congenital vascular anomalies, obviating the need for invasive modalities.
Congenital thoracic vascular anomalies, associated with great risk of mortality and morbidity, include a variety of vascular abnormalities, which mainly include congenital coronary artery anomalies and occur alone or in combination with different forms of congenital heart diseases (CHD) [1]. The incidence of CHD seems to be about 1–2% in the hospitalized pediatric population[2-3]. The global incidence of congenital thoracic vascular anomalies is about 1–2% of the total population; accurate statistics are not available for the prevalence of congenital thoracic vascular anomalies in Iran. Meanwhile, the incidence is increasing worldwide, which is mainly assumed to originate from increased accuracy of the diagnostic methods used [4].
Various diagnostic modalities have been proposed for thoracic vascular anomalies, and several techniques are being proposed [5]. Cardiac catherization, known as angiography, is considered the gold standard diagnostic method for vascular anomalies, but is associated with considerable risk of complications due to its invasive nature [6]. Thus, several imaging techniques have been introduced, which are mainly based on cardiac computed tomography (CCT).
Introduced in the 1970s, computed tomography angiography (CTA) is suggested as a less invasive diagnostic method; however, it is associated with several risks, such as the risk of intravenous contrast administration and radiation exposure[7]. Multidetector computed tomography (MDCT) with the possibility of 2- and 3-dimensial processing[8,10] and magnetic resonance angiography (MRA) [11-12] is conventionally used for diagnosis of congenital thoracic vascular anomalies with favorable results and has several advantages; however, each of the proposed techniques may be associated with its own limitations and complications [13].
Dual-source computed tomography (DSCT) angiography is the most recent CT technology. It is equipped with two X-ray tubes, and simultaneous acquisition of data enables a high temporal resolution of 83 ms [14]. Dual-source has several advantages over single-source CT, including higher heart rates that do not require pre-examination β-blockade, which is a great benefit over MDCT and can thus provide significantly better image quality without motion [15-17]. Reviewing the diagnostic accuracy of DSCT showed a sensitivity of 99% and specificity of 89% for adult patients with coronary artery disease [18]. Comparison of diagnostic accuracy of DSCT in a population with extensive coronary calcifications has shown promising results as well [19]. Although initial studies have evaluated the diagnostic accuracy of cardiac DSCT angiography in adult population it is necessary to evaluate the diagnostic accuracy of DSCT in a pediatric population suffering from congenital thoracic vascular anomalies, considering the fact that diagnosis is an important component of congenital heart diseases, which can result in better treatment outcomes, and the significant mortality and morbidity rates of congenital thoracic vascular anomalies [1], and the suggested advantages of DSCT in other cardiac pathologies. As far as the authors are concerned no study has spotted this issue so far.
Therefore, the present study aimed to determine the diagnostic value of DSCT in congenital thoracic vascular anomalies, in comparison with the gold standard CTA.
Study design
The present cross-sectional study investigated the diagnostic accuracy of DSCT in 100 patients who referred to Shahid Rajaie Heart Center with congenital anomaly of major thoracic vessels, from March 2011 to September 2014. The protocol of the study was approved by Ethics committee of Iran University of Medical Sciences. All principles of Helsinki guidelines were met throughout the study and the patients’ information were kept confidential and analyzed anonymously.
Patients of any age and sex with congenital anomaly of major thoracic vessels, including pulmonary arteries, superior vena cava (SVC), inferior vena cava (IVC), brachiocephalic, azygous, and pulmonary veins, who had undergone digital subtraction angiography (DSA) and DSCT from March 2011 to September 2014 were included in the study by convenient sampling method. Any patient who had other co-morbidities were excluded from the study. Demographic characteristics of participants, such as age, and sex, were recorded from the medical records. DSA and DSCT were performed by 64-slice dual-source CT (Somatome Definition flash; Siemens Medical Solutions, Forchheim, Germany).To confirm the accuracy of DSCT reports, all scans were reviewed by one radiologist. Diagnostic accuracy of DSCT was determined by comparing the results with the results of DSA.
Statistical analysis
Results of quantitative variables were reported by mean ± standard deviation (SD), and categorical variables by frequency (percentage). The diagnostic accuracy was reported by sensitivity. For the statistical analysis, the statistical software IBM SPSS version 22.0 was used. P values less than 0.05 were considered statistically significant.
Of 100 children with congenital anomalies, 60% were boys and 40% were girls. Mean and SD of age of participants was 3.33±3.8 years (range 3–16 years).
A total of 142 anomalies were diagnosed by DSA; of these 4, 2 cases of patent ductus arteriosus (PDA) and 2 cases of LSVC, were not diagnosed by DSCT. Thus, the sensitivity (diagnostic accuracy) of DCST was 97.1%.
In addition, DSCT reported 26 anomalies that were not reported by DSA, including 8 cases of LSVC, 4 cases of overridden aorta on sub aortic VSD, 2 cases of dilated LAD with fistula to right ventricle, 2 cases of right aberrant subclavian artery, 2 cases of right-sided aortic arch, 2 cases of interrupted IVC and hemiazygos vein continuation, and 2 cases of abnormal origin of coronary vessels.
The frequencies of anomalies detected by DSA and DSCT are shown in (Figure 1).
A 5-month old male, known case of VSD, pulmonary hypertension and ASD. Effective PA banding is seen with diameter of 4mm at bending site that is shown in the left figure. 1&2 in the right figure shows entering from right from VSD to aorta. The patient has large sub aortic VSD that LV injection at 70*20 view showed good LV contractility and enlarged LV. Coronary arteries appear with normal origin and course.
An example of known case of VSD, pulmonary hypertension and ASD is illustrated in (figure 1) and another case of known case of subaortic VSD and pulmonary valve atresia is illustrated in ( Figure 2 ).
11 year old male known case of subaortic VSD and pulmonary valve atresia. Severe subvalvular muscular pulmonary stenosis and dome shaped pulmonary valve. In this figure hypoplastic left pulmonary artery and dilated ascending aorta is seen. Aneurysmal dilatation of the ascending aorta is seen with diameter of 43mm. 1- Aneurysmal dilation of ascending aorta(orange arrow) and dilation of AAo(blue arrow) 2- hypoplastic LPA
In a pediatric population (n = 100) aged 3–16 years with congenital thoracic vascular anomalies, a total of 142 anomalies were diagnosed by DSA, 4 of which were not diagnosed by DSCT, resulting in a sensitivity of 97.1% for DCST. Also, there were 26 cases diagnosed by DCST that were not observed by DSA.
Previous studies have confirmed the accuracy of DCST in adult population with various cardiac pathologies. Scheffel et al. investigated adults with coronary artery disease (CAD) with mean age of 63.1±11.3 years; the results of DSCT with invasive coronary angiography showed a sensitivity of 96.4%, and specificity of 97.5%, positive and negative predictive value of 85.7% and 99.4%, respectively, for evaluating CAD [19]. Plass et al. have also determined a sensitivity of 91%, specificity of 99%, a positive predictive value of 92% and a negative predictive value of 99% for evaluating CAD by DSCT[20]. A systematic review of 25 studies on the diagnostic accuracy of DSCT showed a sensitivity of 99% and specificity of 89% for adult patients with coronary artery disease with a median age of 63 years [18]. The results of these studies are consistent with the present study, indicating high sensitivity of DSCT; as in the present study all cases of coronary abnormalities were correctly diagnosed by DSCT.
Ou et al. performed DSCT angiography on 2350 patients and demonstrated 284 segments with congenital coronary artery anomalies in 225 patients and concluded that DSCT can visualize and diagnose congenital coronary artery anomalies perfectly [21], which is parallel to the results of the present study, although they reported descriptive statistics of congenital anomalies in adults and did not compare the results of DSCT with a gold standard diagnostic technique. In the present study, it was demonstrated that all coronary abnormalities diagnosed by DSA were also diagnosed by DSCT; there were no missed cases in DSCT. In addition, 2 cases of abnormal origin of coronary vessels were diagnosed only by DSCT. Although we have not followed-up the patients to see whether these cases were false negative on DSCT or were true positive cases, the results suggest DSCT as an accurate method for diagnosing various congenital thoracic vascular anomalies, including congenital coronary abnormalities. Congenital coronary artery abnormalities have also been proposed to be well diagnosed by MDCT[10]. Further studies comparing DSCT and MDCT can better clarify the differences between these two techniques.
Congenital thoracic vascular anomalies have been investigated with various CT techniques. Yamada et al., although they have not used DSCT, evaluated the diagnostic accuracy of CT for congenital disorders of the great vessels on 850 cases and suggested that it is able to detect the abnormality of these arteries well [22], which is in line with the results of the present study. Researchers have also demonstrated the diagnostic accuracy of MDCT in various congenital thoracic vascular anomalies in pediatric patients [9, 23], which is in line with the results of the present study. Further studies comparing DSCT and MDCT can better clarify the differences between these two techniques.
In addition to the high diagnostic accuracy of CT methods for congenital thoracic vascular anomalies, several advantages have been proposed for DSCT over single-source CT (15), MDCT (17), and other dual-energy CT techniques[24], such as clear images without motion and with few artifacts [16], practicality in high heart rates [25-27], and with high calcifications [19]. The radiation dose of DSCT has also been demonstrated to be safe and lower than of other dual-energy CT techniques [28]. Thus, the above-mentioned studies, along with the results of the present study, suggest that DSCT is a promising technique in detecting congenital thoracic vascular anomalies. Yet, as far as the authors are concerned, previous studies have not evaluated the diagnostic accuracy of DSCT in congenital thoracic vascular anomalies.
The limitations of the present study included lack of follow-up for patients, and limited number of sample size. In addition, the correct diagnosis of positive cases on DSCT, which were not diagnosed by invasive angiography, should be determined by complementary techniques; following-up patients to see the surgical outcome could clarify this ambiguity.
In conclusion, DSCT has a high sensitivity for diagnosis of various congenital thoracic vascular anomalies and can be safely used as a non-invasive diagnostic method for congenital thoracic vascular anomalies in children.
Considering the inadequacy of studies on the application of DSCT on congenital thoracic vascular anomalies in pediatric population, it is suggested that future studies focus on this issue in children, with higher sample size and follow-up.
DSCT has a high sensitivity for diagnosis of various congenital thoracic vascular anomalies and can be safely used as a non-invasive diagnostic method for congenital thoracic vascular anomalies in children.
Considering the inadequacy of studies on the application of DSCT on congenital thoracic vascular anomalies in pediatric population, it is suggested that future studies focus on this issue in children, with higher sample size and follow-up.
There is no conflict of interest regarding the manuscript. There is no financial relationship with the organization that sponsored this research and we have full control of all primary data and it is available for review upon request.
No funding source was applicable for this research.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
